University of Texas MD Anderson Cancer Center, GI Surgery Unit
Houston, Texas, USA
Team
GI Surgical Unit Staff
Aim
As part of their work in the
Transforming Care at the Bedside initiative, the GI Surgical Unit is working to achieve a dramatic decrease in the rate of falls and subsequent harm. As the specific work on falls evolves, the team will define an ultimate numeric goal.
Measures
Falls rate: Number of inpatient falls x (1,000), divided by the total number of inpatient days
"Falls" are defined as an unplanned descent to the floor by a patient (must hit the floor or an extension of the floor, such as the foot of a piece of furniture).
- Includes witnessed and unwitnessed falls
- Includes patients eased to the floor but excludes patient eased to chair
Changes
Many hospital units are working on preventing the rate of and harm from falls without the benefit of a formal change package that addresses this specific area of risk. The MD Anderson Cancer Center’s GI Surgical Unit has done the following to reduce the rate of and harm from falls:
- Tested a variety and combination of formal assessment tools for falls, including the Morris and Hendricks Assessments, and are in the process of customizing their own assessment tool based on these
- Drilled down into their post-fall assessment data regarding the nature of patient falls in the unit, and determined that the majority of falls occur around elimination needs (i.e., patients needing to get up to go to the bathroom)
Results
Summary of Results / Lessons Learned / Next Steps
Through their diligent work in this area, MD Anderson Cancer Center’s GI Surgical Unit has decreased the average rate of falls by 76 percent in nine months, from an average rate of 2.72 before the interventions (January 2004 through August 2004) to an average of 0.67 after the interventions (September 2004 through July 2005).
The team is currently reviewing their data and falls prevention program in efforts to formalize the assessment, prevention, and follow-up process in order to realize further improvements in their falls rate, and to sustain the gains already seen. They plan to then spread their improvements to the remainder of the hospital.
Going forward, the GI Surgical Unit plans a two level falls prevention program: basic and high-risk.
Basic Prevention Program:
- The basic level will be instituted for all patients. It involves common sense items such as locking furniture and transportation wheels; environmental safety changes such as securing wires and cords, and using bars and handles in patient rooms; and use of non-skid slippers by patients.
- In addition, the team has implemented an education program for all staff to instill the philosophy that falls prevention is everyone’s responsibility.
High-Risk Prevention Program:
- The high-risk level targets patients for the first 72 hours post surgery. Components include routine and frequent room checks and toileting rounds. Room checks use a checklist that includes both environmental factors and patient needs (offering toileting, pain medications, etc.). The high-risk designation also mandates a bedside commode with staff assist and presence.
- The team is considering implementing a policy that would require staff to stay in the bathroom with patients who are assessed to be at the very highest risk for falls.
A team of IHI content experts has reviewed this report and determined that it is a compelling example of current results from organizations working with IHI.
